<table class='grid' cellpadding="0" cellspacing="0" style="width: 100%">
	<tr>
		<td class="form_label" style='width: 35%'>{translate}Patient{/translate}:</td>
		<td colspan='2'><span class='label' style='text-transform: uppercase'>
			{$patientName}
			{if $patientGender=='male'}
	          	({translate}Male{/translate}
	        {else}  
	            ({translate}Female{/translate}
	        {/if}
			{if ($patientAge != '' && $patientCareer != '')}
				{translate p1=$patientAge p2=$patientCareer}, Age: %s, %s){/translate}
			{elseif $patientAge != ''}
				{translate p1=$patientAge}, Age: %s){/translate}
			{elseif $patientCareer != ''}
				, {$patientCareer})
			{else}
				)
			{/if}
		</span></td>
	</tr>
	<tr>
		<td class="form_label">{translate}Doctor{/translate}:</td>
		<td colspan='2'><span class='label'>{$treatedDoctor}</span></td>
	</tr>
	<tr>
		<td class="form_label">{translate}Diagnosis{/translate}:</td>
		<td colspan='2'><span class='label'>{$diagnosis}</span></td>
	</tr>
	<tr>
		<td class="form_label">{translate}ICD10{/translate}:</td>
		<td style='width: 40px'><span class='label' id='icd10CodePrimary'>{$icd10PCode}</span></td>
		<td><span class='label'>{$icd10PName}</span></td>
	</tr>
	<tr>
		<td class="form_label">{translate}Treatment result{/translate}:</td>
		<td colspan='2'>
			<select name="treatmentResult" id="treatmentResult" style="max-width: 300px; min-width: 100px;">
			    {html_options options=$treatmentResultList}  
			</select>
		</td>
	</tr>
</table>